Shingles - Lecture Note

Skin Infection : Shingles Definition, Incidence and Risk Factors Herper Zoster or Shingles is a local disease brought on by reactivity from the same virus that causes a systemic disease called varicella (chicken pox). The main infection of varicella is generally in children. Infection Shingles can occur at any age, the peak incidence occurs at age 50–70 year. This disease is usually caused by a weakened immune system as occurs in malignant tumors or AIDS. Pathogenesis Harpes Zoster results from reactivation of the varicella virus which is no longer active cerebral ganglia (extramedullary ganglia of the cranial nerves) or posterior root ganglia nerves from before chicken pox occurs. How or why it is active again what could happen is not known for certain at this time. One explanation is that it is a virus multiply because it reactivates and is neutralized by remaining antibodies from initial infection. If effective antibodies do not occur, the virus will continue to grow multiply in ganglia, damage host neurons and spread downward to sensory nerves skin. Clinical Manifestations An affected person may experience some early signs (prodromal symptoms) where the virus becomes active again, especially during incidents which is repetitive. The initial symptoms of pain and tingling along the dermatome spinal or cranial nerves are affected, which is usually accompanied by fever, chills (feeling cold and stiff0, feeling unwell, and gastrointestinal disorders. One Until three days later, red papules appear along the dermatomal area (fig. 8-6). These lesions most often spread unilaterally around the thorax or vertically on both arms or legs. Herpetic papules quickly develop into various vesicles in size and can contain clear fluid or pus. these vesicles limited to the distribution of the infected nerve root and begins to dry out five days after eruption with gradual and progressive healing over 2-4 weeks. Post herpetic neuralgia can occur and increase sharply in people who over 60 years old. Children usually do not get postherpetic neuralgia. In adulthood, severe neuralgia can occur in peripheral areas innervated by nerves originating from inflamed nerve root ganglia. Pain can occur is constant or intermittent and varies from a burning sensation mild to deep and visceral pain sensations. The duration of neuralgia can be occurs over weeks or months to years. Treatment There is no medicine that specifically cures shingles (nervous rash). but what is currently circulating is only supportive treatment which aims to reduces the itching and neuralgia pain felt by the patient. Giving systemic corticosteroids in the first week can prevent this as well reduces attacks and the emergence of acute signs and symptoms and also all risks post herpetic neuralgia in the elderly Acyclovir (Zovirax) can reduce and stop the speed of rashes (skin redness) and also prevents visceral complications. A newer type of drug (Famciclovir) can Compared with Acyclovir in effectiveness but has a shorter duration of action longer and given in smaller doses. Patients with varicella- Zooster must be treated in an isolation room and everyone who enters it the room must wear special clothes, gloves and masks. If This zoster virus attacks the eyes so the patient must receive treatment and evaluation from ophthalmology. The live varicella vaccine (Varivax) is recommended for use by Food and Drug Administration (FDA) for use in patients aged 12 years or older who have never experienced varicella. Until the varicella vaccine can be widely used , effective method for To prevent exposure to varicella infection that can be used is varicella-zooster immune globulin (VZIG). This preparation is made from collected plasma donations from individuals who are known to have high titer antivaricella antibodies and are given to people with recommendations for several categories of people at risk high exposure to varicella infection. The people in question are people who requires high antibodies such as the oars of a healthy person aged 25 years or older, pregnant women, or women under internal medical supervision the condition of the pregnancy, a newborn baby with a history of the baby's mother suffering varicella between 5 days before and 48 hours after birth, premature babies who was treated after 28 weeks with a history of suffering during pregnancy varicella and also premature babies treated less than 28 weeks of age without a history of maternal pregnancy with varicella infection. Prognosis Overall the prognosis is good if the infection does not attack the brain and this happens very rarely. In general people recover completely with the exception that there may be scarring/scar tissue and damage cornea, and visual impairment. Often the pain caused occurs and affected and associated with neuralgia for months or even years. Patients with postherpetic neuralgia require further treatment. Specific implications for physiotherapists Herpes Zoster Adults with shingles can get sick quickly infect other people who do not suffer from chickenpox. For this reason, physiotherapists who have never suffered/experienced chickenpox need to accept vaccination; complications and morbidity associated with varicella attacks in adults will require these precautions. At the physiotherapist women who are pregnant or planning a pregnancy should be tested for status immunity if you are not sure if there is a previous history of varicella. This matter This is very important because the transmission of the virus takes 2 to 3 days before symptoms appear until the entire lesion has crusted (hardened) on top skin. This means that someone is receiving treatment from someone physiotherapist will probably be asymptomatic in his body during the period transmission; exposed to infection itself and further transmission to others can occur without the physiotherapist realizing it. The Centers for Disease Control and Prevention (CDC= Centers of Disease Control) has provides instructions for care for all clients regarding procedures prevention of transmission of infectious skin diseases. These universal precautions (see Appendix A) should be used by all clients regardless of their disease status. All skin diseases are very potential It spreads quickly and must be treated accordingly. Besides every a hospital that has an isolated and suitably organized preventive room with the disease category can prevent the spread of infectious diseases to other people. Every health professional must be familiar with these procedures and follow it carefully. Neither heat nor ultrasound modalities should be used on a person with shingles because this modality can increase the severity of the marks and the symptoms the person is experiencing. Because in people with pain conditions severe and irritating herpes, relaxation techniques may be helpful. In in cases of unresolved postherpetic neuralgia, the individual may receive a chronic pain management program.